Healthcare Provider Details

I. General information

NPI: 1043148794
Provider Name (Legal Business Name): TATIANA HEFFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 E CRAIG RD UNIT 2064
LAS VEGAS NV
89115-1858
US

IV. Provider business mailing address

4730 E CRAIG RD UNIT 2064
LAS VEGAS NV
89115-1858
US

V. Phone/Fax

Practice location:
  • Phone: 907-793-7904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRN
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: